What Causes Arthritis in the Foot and Ankle

Arthritis in the foot and ankle is a common condition that can significantly affect your ability to move and carry out daily activities. It happens when the cartilage in a joint breaks down, leading to pain, stiffness and difficulty in the movement.

This article explains what Arthritis is, what causes it, how to recognise it, and the treatment options available. These insights are based on the expertise of Mr. Garth Allardice, a respected consultant orthopaedic surgeon.

What is Arthritis?

Arthritis is the wear and tear or inflammation of a joint's cartilage and other components. Cartilage acts as a cushion between the bones. It can cause the bones to rub against each other when it deteriorates. This leads to pain, swelling and stiffness in the affected joint.

In the foot and ankle, Arthritis can occur in different areas, such as the big toe, the ankle or other joints, depending on the cause.

For instance, Arthritis in the big toe joint is often caused by repetitive stress or hereditary factors, while Arthritis in the ankle commonly stems from previous injuries. Regardless of its origin, the result is a gradual loss of joint function that impacts everyday tasks like walking or standing.

Causes of Foot and Ankle Arthritis

There are several reasons why Arthritis might develop in the foot or ankle. The most common causes are:

Primary Osteoarthritis

Primary Osteoarthritis is linked to ageing and often runs in families. This form of Arthritis typically affects the big toe joint and occurs as cartilage naturally wears down over time.

Post-Traumatic Arthritis

Post-Traumatic Arthritis is another significant cause, particularly in the ankle. Mr. Allardice explains that this form of Arthritis is:

"Most often caused by severe ankle fractures or recurrent injuries that destabilise the joint, leading to long-term damage."

The repeated stress from these injuries causes the cartilage to break down, leaving the joint vulnerable to further wear.

Inflammatory Arthritis

Inflammatory Arthritis, such as rheumatoid Arthritis or gout, can also affect the foot and ankle. Rheumatoid Arthritis is an autoimmune condition in which the body's immune system mistakenly attacks the joints, causing inflammation and cartilage damage.

Gout occurs when uric acid crystals build up in the joint, resulting in sudden, intense pain, swelling and stiffness.

Other less common causes include septic Arthritis, where an infection in the joint damages the cartilage and neuropathic Arthritis, often seen in people with advanced diabetes.

In rare cases, Arthritis may be linked to congenital abnormalities in the foot or ankle, where structural issues from birth lead to early joint damage.

Arthritis Symptoms

The most noticeable symptoms of Arthritis in the foot and ankle are pain, swelling and reduced movement.

Pain is typically described as a deep ache. This can worsen with activity, such as walking or standing for extended periods. Over time, the pain may become more persistent, occurring even when resting or during the night.

Swelling is another key symptom. It increases with activity and can make the area around the joint feel tender and stiff. Applying ice packs or taking anti-inflammatory medications can help reduce swelling temporarily, but the underlying issue will often remain until further treatment is sought.

Loss of movement is a common issue as Arthritis progresses. You may notice that the affected joint feels stiff, or you have difficulty bending your toes or moving your ankle. This loss of function can significantly impact your ability to perform simple tasks like climbing stairs or driving.

In some cases, deformities such as bunions or misaligned toes may develop due to the condition.

How is Arthritis Diagnosed?

Diagnosing Arthritis starts with a thorough consultation with a medical professional. During this assessment, your doctor will ask about your symptoms, medical history and any previous injuries that might have contributed to the condition. This discussion helps identify potential causes and assess the impact on your daily life.

A physical examination is the next step. The doctor will check for swelling, tenderness and range of motion in the affected joint. They will also assess how Arthritis affects neighbouring joints, as these can sometimes compensate for the damaged area and develop issues over time.

Imaging tests, such as X-rays, are often used to confirm Arthritis and determine its severity. X-rays can show the extent of cartilage loss, the presence of bone spurs, or any changes in the alignment of the bones.

In some cases, an MRI or CT scan may be recommended to get a clearer view of soft tissues and detect early signs of damage. Blood tests may also be carried out if an inflammatory condition like rheumatoid Arthritis or gout is suspected.

Treatment Options

Treating Arthritis often starts with non-surgical approaches. Medications are commonly prescribed to manage pain and reduce inflammation. Over-the-counter painkillers like paracetamol or anti-inflammatory drugs can be effective in relieving mild symptoms.

For those with inflammatory Arthritis, more potent medications such as corticosteroids or disease-modifying drugs (DMARDs) may be necessary to address the underlying condition.

Physical therapy is a valuable part of managing Arthritis. A physiotherapist can design a personalised exercise programme to help improve joint strength and flexibility, reduce pain and restore mobility. Techniques such as stretching and low-impact exercises can help maintain joint function without putting undue strain on the affected area.

Supportive devices can also make a big difference. Custom orthotics, braces or specially designed footwear can help redistribute pressure and relieve pain.
Lifestyle changes, such as maintaining a healthy weight and avoiding high-impact activities, are essential in managing symptoms and preventing further damage.

If non-surgical methods are not effective, surgical options may be considered. Joint fusion, or arthrodesis, is a standard procedure where the bones in the joint are fused to eliminate pain. However, this also limits movement in the joint.

For those with more severe Arthritis, joint replacement surgery could be considered. This involves using an artificial implant to replace the damaged joint, which can help relieve pain and restore movement.

Managing Life with Arthritis

While Arthritis can be challenging, there are ways to manage it and improve your quality of life. Early diagnosis is key to slowing its progression and preventing further complications. Regular check-ups with a specialist can ensure that your treatment plan is working and can be adjusted if necessary.

Making changes to your lifestyle can also help. Engaging in low-impact activities like swimming or cycling can maintain joint flexibility without causing additional stress. A balanced diet consisting of anti-inflammatory foods such as leafy greens and nuts can support overall joint health. If you are overweight, losing even a small amount can reduce the strain on your joints and alleviate symptoms.

Mr. Allardice emphasises the importance of seeking professional advice. By understanding the condition and exploring the available treatments, you can take control of your symptoms and improve your mobility.

With the proper support and approach, Arthritis in the foot and ankle can be managed effectively, allowing you to maintain an active and fulfilling life.